How automatic notification of infectious disease specialists impacted the management of Staphylococcus aureus bacteremia in a community hospital setting

Figures & data

Table 1. Patient demographics.

	Pre Intervention (N = 57)	Post Intervention (N = 60)	p-value*
Average patient age (years)	64 (SD = 15.06)	62 (SD = 16.03)	0.53
Male (#, %)	N = 36, 63%	N = 38, 63%	0.93
Diabetes Mellitus (#, %)	N = 26, 46%	N = 30, 50%	0.70
End Stage Renal Disease on Dialysis (#, %)	N = 13, 23%	N = 16, 27%	0.67
Immunosuppressed (#, %)	N = 9, 16%	N = 8, 13%	0.68

SD = standard deviation

*Independent t test performed.

Table 2. Primary and secondary outcomes.

	Pre- intervention (N = 57)	Post- intervention (N = 60)	p-value*
Inpatient Mortality (#, %)	N = 5^a, 9%	N = 11^b,18%	0.09
30 day Mortality (#, %) (including in-patient mortality)	N = 10, 18%	N = 12, 20%	0.10
Bedside ID Consult (#, %)	N = 43^c, 75%	N = 47^d, 78%	0.15
MRSA Prevalence (#, %)	N = 31, 54%	N = 34, 57%	0.74
Complicated bacteremia (#, %)	N = 38/53^e, 70%	N = 37/54^f, 69%	0.08
Duration of hospitalization (days)	N = 12.2	N = 9.5	0.03
Readmitted within 30 days (#, %) (excluding 30 day mortality)	N = 19/47, 40%	N = 9/48, 19%	0.03

^a 3 patients did not have Infectious Disease involvement

^b 6 patients did not have Infectious Disease involvement. In 4 cases family elected withdrawal of care, 1 patient died with inpatient hospice.

^c 10 of these patients were under the care of an Infectious Disease physician in a Hospitalist role. Two patients had care that coordinated with Infectious Disease as a ‘telephone consult’ that are not considered as an ID consult in this number.

^d 1 of these patients was under the care of an Infectious Disease physician in a Hospitalist role. Three of these patients had care that was coordinated with Infectious Disease as a ‘telephone consult.’ that are not considered as an ID consult in this number.

^e 4 patients unable to be designated into a category due lack of data secondary to early mortality or hospital transfer.

^f6 patients unable to be designated into a category due to lack of data secondary to early mortality or hospital transfer.

* Independent t test performed.

Table 3. Compliance with IDSA guidelines.

	Pre-intervention N = 57	Post-intervention N = 60	p-value*
Blood cultures repeated (#, %)	N = 45, 79%	N = 53, 88.3%	0.62
Transesophageal echocardiogram (#, %) (TEE)	N = 28^a, 49%	N = 33, 55%	0.47
Source identified (#, %)	N = 43, 75%	N = 45, 75%	1.0
Duration of antibiotics prescribed for uncomplicated bacteremia (#, %)	14 days: N = 9/12, 75% >14 days: N = 3/12, 25%	14 days: N = 9/15, 60% >14 days: N = 6/15, 40%	0.55
Duration of antibiotics prescribed for complicated bacteremia (#, %) (prescribed antibiotics at discharge)	<28 days: N = 13/30, 43% ≥28 days: N = 17/30, 57%	< 28 days: N = 4/26, 15% ≥ 28 days: N = 22/26, 85%	0.004

^a 1 patient refused

*Independent t test performed

Table 4. Source of bacteremia.

	Pre-intervention N = 57	Post-intervention N = 60
Skin and soft tissue	N = 9	N = 9
Osteoarticular	N = 7	N = 10
Endocarditis	N = 7	N = 9
Pneumonia	N = 5	N = 8
Central Venous catheter	N = 7^a	N = 2^b
Peripheral venous catheter	N = 5	N = 1
Other	N = 3^c	N = 3^d
Urinary tract	N = 0	N = 3
Focus not clearly identified	N = 14^e	N = 15^f

^a 6 were associated with permacatheters.

^b 1 was associated with a permacatheter.

^c 1 was related to a bypass graft, 1 was an automatic implantable cardioverter defibrillator device infection and 1 was an AV fistula infection.

^d 1 was a bypass graft, 1 was a pseudo-aneurysm infection, 1 was a pacemaker lead infection.

^e 3 patients died during hospitalization.

^f 4 patients died during hospitalization.

Table 5. Antibiotic prescribed within 24 hours of identification of MSSA bacteremia.

Antibiotic	Frequency Pre- intervention N = 23^a	Frequency Post- intervention N = 26	p-value *
Cefazolin	N = 7, 30%	N = 17, 65%	0.075
Ciprofloxacin	N = 2, 9%	N = 1, 4%	**
Ertapenem	N = 1, 4%	N = 2, 8%	**
Daptomycin	N = 1, 4%	N = 0	**
Nafcillin or oxacillin	N = 9, 39%	N = 2, 8%	0.021
Vancomycin	N = 3, 13%	N = 4, 15%^b	**

a 3 patients of the total of 26 cases of MSSA bacteremia were excluded due to missing data (1 died, 2 were transferred prior to cultures).

b 3 patients had a documented penicillin or cephalosporin allergy.

* Independent t test performed.

** Numbers too small to calculate p values.